II. Definitions:

  1. Pediatric Isotonic Dehydration
    1. Serum Sodium: 130 - 150

III. Protocol: Example Case

  1. Weight: 35 kg Child
  2. Dehydration: 10%
  3. Serum Sodium: 140 (Normal)

IV. Protocol: Stabilization with Bolus Fluids (Phase I)

  1. See Pediatric Dehydration Management
  2. Give 20 ml/kg Normal Saline or Lactated Ringers over 10-15 minutes
  3. May repeat bolus until circulation stable
    1. May require up to 60 ml/kg within the first 1-2 hours

V. Protocol: Calculate Maintenance Fluid Requirements

  1. Approach as per Pediatric Dehydration Management
  2. See Maintenance Fluid Requirements in Children
  3. Hourly = 75 cc/hour for 35 kg child
    1. First 10 kg: (4 cc/kg/hour x 10 kg)
    2. Next 10 kg: (2 cc/kg/hour x 10 kg)
    3. Remaining 15 kg: (1 cc/kg/hour x 15 kg)
  4. Daily: 1800 cc/day

VI. Protocol: Calculate Remaining Deficit to be Replaced

  1. See Pediatric Dehydration Management
  2. Estimate level of dehydration
    1. Mild Dehydration (3%) = 30 ml/kg
    2. Severe Dehydration (12%) = 120 ml/kg
  3. Subtract Phase 1 Resuscitation already replaced
  4. Calculation
    1. Phase 1: 20 ml/kg/bolus x 35 kg x 1 bolus = 700 ml
    2. Deficit (10%): 100 ml/kg x 35 kg = 3500 ml
    3. Remaining Deficit: 3500 ml - 700 ml = 2800 ml

VII. Protocol: Divide 2800 cc Remaining Deficit over 24 hours

  1. First 8 hours: 75 ml/h + 1400 ml/8h = 250 ml/hour
  2. Next 16 hours: 75 ml/h + 1400 ml/16h = 163 ml/hour

VIII. Protocol: Saline guide (Rough)

  1. Precautions
    1. Exercise caution with hypotonic solutions (Hyponatremia)
    2. Consider D5 NS as maintenance fluid instead of D5 1/2NS
    3. McNab (2015) Lancet [PubMed]
  2. Weight <28 kg: D5 1/2NS (prior recommendation D5 1/4NS)
  3. Weight >28 kg: D5 NS

IX. Protocol: Summary - 35 kg Child with isotonic dehydration

  1. Initial Bolus: 700 ml (20 ml/kg)
  2. First 8 hours: D5 NS with 20 KCl at 250 ml/hour
  3. Next 16 hours: D5 NS with 20 KCl at 163 ml/hour

X. Resources

XI. References

  1. Walton (2020) Crit Dec Emerg Med 34(6): 3-9
  2. Canavan (2009) Am Fam Physician 80(7):692-6 [PubMed]

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